Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: A retrospective study

Scaravilli, Vittorio; Grasselli, Giacomo; Castagna, Luigi; Zanella, Alberto; Isgrò, Stefano; Lucchini, Alberto; Patroniti, Nicolò; Bellani, Giacomo; Pesenti, Antonio

doi:10.1016/j.jcrc.2015.07.008

Cited by 249 publications

(281 citation statements)

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“…In a study with patients experiencing dyspnea, it was found that the patients generally preferred the seated leaning forward position (4). Examining the literature it is seen that there have been many studies on the effect of prone position (5,7,9,10), the supine position (3,6,9,23,24), semifowler (6), and right and left lateral positions (3,23,24), but there have been few on the orthopnea position (4,8,24,25).…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the alveoli which were closed in the supine position open, and this helps the heterogeneous structure of the lung in ARDS to change, and to attain a more homogeneous structure (29). In this way it has been established in many studies that oxygenation is generally better with patients in the prone position (7,9,10,15). It was found in another study that the prone position improved SpO 2 and decreased respiratory distress as compared to the supine position in neonates with respiratory distress.…”

Section: Discussionmentioning

confidence: 99%

“…In the literature there are many studies on the effects of the prone position on ARDS patients. As a result of many studies of prone positioning in ARDS, turning patients into the prone position is accepted as a reliable and beneficial procedure (7,10,16).Prone position, patient lie on their abdomens with the head turned to one side; the hips are not flexed. Perfusion is greater in the dorsal aspects of the lungs, no matter what the patient's position.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Different Position Changes on Hemodynamic Parameters and Dyspnea Severity in Patients with Dyspnea

Baysal¹,

Midilli²,

Ergın³

2017

Clin Exp Health Sci

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Objective: This study was planned to determine the effects of different position changes on hemodynamic parameters and dyspnea severity in patients with dyspnea. Methods: This was a quasi-experimental study, using a one-group, pre-test and posttest design. From March-December, 2015, 58 pulmonary service patients who had been hospitalized due to dyspnea and various respiratory diseases were assessed for dyspnea severity, oxygen saturation (SpO 2 ), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and respiratory rate (RR). Results: According to repeated measures variance analysis of patients in the prone and orthopnea position, there was no statistically significant difference between the measurement of dyspnea severity, O 2 saturation, SBP, DBP, and RR. However, the HR of patients increased in the prone position and dyspnea severity was shown to be reduced in the orthopnea position. Conclusion: Comparing all the positions given to the patients, it was found that towards the 15 th minutes, the orthopnea position had a positive effect on patients' mean dyspnea severity, SBP and O 2 saturation but a significant difference was observed only on the mean dyspnea severity. ÖZAmaç: Dispnesi olan hastalarda pozisyon değişiminin yaşamsal bulgular, oksijen saturasyonu ve dispne şiddeti üzerine etkisini belirlemek amaçlanmıştır. Matreryal Metot: Bu araştırma ön test ve son test tasarımı kullanılan yarı deneysel bir çalışmadır. Mart-Aralık 2015 tarihleri arasında göğüs hastalıkları servisinde dispne ve çeşitli solunum hastalıkları nedeniyle yatarak tedavi gören 58 hastanın dispne şiddeti, oksijen saturasyonu (SpO 2 ), sistolik kan basıncı, diyastolik kan basıncı, kalp hızı ve solunum hızı değerlendirilmiştir. Bulgular: Tekrarlayan varyans analizi sonuçlarına göre hastaların prone ve ortopne pozisyonunda dispne şiddeti, O 2 saturasyonu, sistolik kan basıncı, diyastolik kan basıncı ve solunum hızı istatistiksel olarak anlamlı farklılık göstermemiştir. Fakat hastaların kalp hızı prone pozisyonunda artış göstermiş ve dispne şiddeti ise ortopne pozisyonunda azalmıştır. Sonuç: Hastalara verilen tüm pozisyonlar karşılaştırıldığında, ortopne pozisyonunun 15. dakikasında hastaların ortalama dispne şiddeti, sistolik kan basıncı ve O 2 satürasyonunda pozitif bir etki olduğu fakat sadece ortalama dispne şiddetinde anlamlı bir fark olduğu saptanmıştır. Anahtar Kelimeler: Pozisyon değişimi, dispne algısı, hemodinamik parametreler, prone pozisyonu, ortopne pozisyonu

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of Different Position Changes on Hemodynamic Parameters and Dyspnea Severity in Patients with Dyspnea

Baysal¹,

Midilli²,

Ergın³

2017

Clin Exp Health Sci

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“…Proning positioning has been reported to work in critically ill COVID-19 patients with moderate-to-severe acute respiratory distress syndrome [1]. Patients who are moderately hypoxemic can be proned early to improve oxygenation if oxygen supplies are limited, presumably even if they are not invasively ventilated [9]. Other approaches to save ICU resources include using enteral vasopressors, such as midodrine for hypotensive patients, instead of intravenous formulations [10].…”

Section: Treatmentmentioning

confidence: 99%

Managing COVID-19 in resource-limited settings: critical care considerations

et al. 2020

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“…The mortality (33%) in this supine group [27] was similar to the mortality in the latest trials (conventional group: 35% [103] or 41% [104]; low Vt: 31% [105]). Moreover, proning (2−8 h) in non-intubated patients increases the P/F in moderate ARDS (pre: 124 ± 50; prone: 187 ± 72; post: 141 ± 64) [106].…”

Section: ) or < 26 CM H 2 O [41] When The Rv Is Considered ( § I A 2)mentioning

confidence: 92%

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

Petitjeans

Pichot²,

Ghignone

et al. 2016

Anaesthesiol Intensive Ther

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Severe acute respiratory distress syndrome (ARDS, PaO 2 /FiO 2 < 100 on PEEP ≥ 5 cm H 2 O) is treated using controlled mechanical ventilation (CMV), recently combined with muscle relaxation for 48 h and prone positioning. While the amplitude of tidal volume appears set £ 6 mL kg -1 , the level of positive end-expiratory pressure (PEEP) remains controversial. This overview summarizes several salient points, namely: a) ARDS is an oxygenation defect: consolidation/difuse alveolar damage is reversed by PEEP and/or prone positioning, at least during the early phase of ARDS b) ARDS is a dynamic disease and partially iatrogenic. This implies that the management of the ventilator may be a life-saver by reducing the duration of mechanical ventilation, or detrimental by extending this duration, leading into critical care-acquired diseases. Indeed, a high PEEP (10−24 cm H 2 O) appears to be a life-saver in the context of early severe diffuse ARDS; c) tidal volume and plateau pressure cannot be identical for all patients; d) the only remaining rationale for CMV and muscle relaxation is to suppress patient-ventilator asynchrony and to lower VO 2 , during the acute cardio-ventilatory distress. Therefore, in early severe diffuse ARDS, this review argues for a combination of a high PEEP (preferably titrated on transpulmonary pressure) with spontaneous ventilation + pressure support (or newer modes of ventilation). However, conditionalities are stringent: upfront circulatory optimization, upright positioning, lowered VO 2 , lowered acidotic and hypercapnic drives, sedation without ventilatory depression and without lowered muscular tone. As these propositions require evidence-based demonstration, the accepted practice remains, in 2016, controlled mechanical ventilation, muscle relaxation, and prone position.

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Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: A retrospective study

Cited by 249 publications

References 28 publications

Effects of Different Position Changes on Hemodynamic Parameters and Dyspnea Severity in Patients with Dyspnea

Effects of Different Position Changes on Hemodynamic Parameters and Dyspnea Severity in Patients with Dyspnea

Managing COVID-19 in resource-limited settings: critical care considerations

Early severe acute respiratory distress syndrome: What’s going on? Part I: pathophysiology

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